1. THE IRRATIONAL USE OF DRUGS IN RURAL CHINA: EVIDENCES FROM TWO PROVINCES Qiang SUN, Jia YIN, Genyong ZUO, Qingyue MENG Center for Health Management & Policy, Shandong University

2. Background Overuse, under use, or misuse of drugs has resulted in wastage of scarce resources, poor quality and unnecessary costs of health care. The irrational use of drugs in rural China is unclear Ministry of Health has issued policies and carried out health promotion activities for improving the use of drugs rationally in the hospitals and in the communities.

3. Study Aims To evaluate the basic situation of rational use of drugs in rural China by studying the behavior and perception of health care providers and rural residents.

4. Methods 1 Design: – A cross-sectional study was designed to evaluate the use of drugs in rural China Setting: – Shandong and Ningxia provinces in 2008. – In each province, the public hospitals and rural community were the basic study sites

5. Methods 2 3 counties, 9 towns and 54 villages were randomly sampled in each province Total 13,481 rural residents were investigated in two provinces 3,000 prescriptions were randomly collected from county hospitals to village clinics in two provinces 49 health care providers from different levels were interviewed

6. Results 1 Health facilitiesNo. of PreAver. No. of DrugsAver. cost(RMB) County hospital Township health center Village clinic 300 900 2.09 3.10 4.55 72.3 39.9 27.4 The average No. of drugs and drug cost in Shandong The average No. of drugs and drug cost in Ningxia Health facilitiesNo. of PreAver. No. of DrugsAver. cost(RMB) County hospital Township health center Village clinic 300 900 2.66 3.13 2.80 64.2 17.7 9.6

7. Results 2 Health facilities% of prescriptions with Antibiotics in Shandong % of prescriptions with Antibiotics in Ningxia County hospital Township health center Village clinic 40.3 64.0 75.3 58.0 71.7 66.2 χ2Pχ2P 123.659 ＜ 0.001 12.735 0.005 Accustomed prescription practices of rural health providers and economic incentives from selling drugs are the main reasons resulted in the high antibiotic utilization High Antibiotic use

8. Results 3 Health facilities% of prescriptions with Injections in Shandong % of prescriptions with Injections in Ningxia County hospital Township health center Village clinic 20.3 51.0 53.9 54.0 58.7 45.8 χ2Pχ2P 104.726 ＜ 0.001 17.351 0.001 Wrong beliefs: The rural patients actively require using the injections as they believe the effect of injections is better than oral drugs. Economic incentives: The injective drugs usually had higher mark-up High Injection Use

9. Results 4 Poor knowledge: over 50% of surveyed populations don’t know consequence of irrational use of antibiotics in both provinces. Poor adherence: 54.6% and 60% of the rural patients can not comply with medical advice to take drugs in Shandong and Ningxia respectively.

10. Summary 1 The irrational use of medicines is very severely in rural China in terms of high antibiotic use and injection use Economic incentives and lack of continuous training to health care providers are main reasons

11. Summary 2 Poor knowledge, wrong beliefs and poor adherence of rural residents on drug use worse the irrational use of medicines

12. Policy implication and conclusion Implementing continuous on-the-job trainings on and reforming the incentive mechanism for rural health providers are urgent and essential for improving rational use of drugs in rural China. Targeted health promotions on rural residents for improving their knowledge and setting up correct beliefs on rational drug use are also important.